Tracheostomy

A tracheostomy is a surgically created opening in the front of the neck that leads directly into the windpipe (trachea). A tracheostomy tube is placed through this opening to help with breathing, airway protection or secretion management.

Some people need a tracheostomy for a short period during critical illness, while others require longer-term support. Once the acute phase in an intensive care or acute hospital is over, many patients benefit from specialist rehabilitation in a setting experienced in tracheostomy care and weaning.

At The Royal Buckinghamshire Hospital, we provide inpatient rehabilitation for adults with tracheostomies, often alongside complex neurological, respiratory or medical conditions.

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Why a tracheostomy may be needed

Common reasons for a tracheostomy include:

• Prolonged mechanical ventilation in intensive care
• Difficulty weaning from a ventilator
• Neurological conditions affecting the muscles used for breathing or swallowing (e.g. spinal cord injury, brain injury, neuromuscular disease)
• Severe obstruction of the upper airway (e.g. swelling, tumour or trauma)
• The need for frequent suctioning of secretions that cannot be managed safely via the mouth

In many cases, the long-term goal is to wean the person from the tracheostomy tube once it is safe to do so.

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Living with a tracheostomy – common challenges

People with a tracheostomy may experience:

• Dependence on a ventilator (invasive ventilation) in some cases
• Changes in voice or inability to speak without specialist devices
• Difficulty managing saliva and secretions
• Increased risk of chest infections if secretions are not cleared effectively
• Anxiety or low mood related to breathing, communication and appearance
• Reduced ability to eat and drink normally if swallowing is affected
• Dependence on others for suctioning, tube care and equipment

These challenges can have a major impact on independence, confidence and quality of life, especially following a prolonged critical illness or neurological injury.

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Tracheostomy care

Safe tracheostomy care includes:

• Regular suctioning of secretions when needed
• Humidification to prevent the airway drying out
• Careful cleaning and inspection of the stoma (the opening in the neck)
• Routine tube changes at appropriate intervals
• Monitoring for infection, bleeding, blockage or displacement
• Appropriate use of speaking valves and caps where indicated

This care is usually provided by trained nurses and therapists working within agreed protocols, with medical oversight.

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Tracheostomy weaning and decannulation

Where possible, the goal is to gradually reduce dependence on the tracheostomy and remove the tube altogether (decannulation).

Typical steps may include:

• Optimising chest physiotherapy and secretion clearance
• Gradual reduction in ventilator support, if used
• Cuff deflation trials (for cuffed tubes)
• Use of a speaking valve or cap for progressively longer periods
• Monitoring of breathing, oxygen levels and carbon dioxide
• Swallowing assessments to ensure the person can protect their airway
• Trial periods with the tube capped before full decannulation

Weaning is highly individual and must be guided by an experienced multidisciplinary team.

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Tracheostomy rehabilitation at The Royal Buckinghamshire Hospital

The Royal Buckinghamshire Hospital provides specialist inpatient rehabilitation for adults with tracheostomies, often following:

• Prolonged critical illness and intensive care stays
• Spinal cord injury
• Acquired or traumatic brain injury
• Neuromuscular conditions
• Complex medical and surgical admissions

Multidisciplinary team (MDT)

Your rehabilitation and tracheostomy care may involve:

• Consultants in Rehabilitation Medicine and/or Neurology
• Specialist rehabilitation doctors
• Experienced tracheostomy and respiratory nurses
• Physiotherapists
• Speech and language therapists
• Dietitians
• Occupational therapists
• Neuropsychologists and clinical psychologists

The team works together to promote safe breathing, communication, swallowing and mobility, while planning for long-term needs and discharge.

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Rehabilitation focus areas

Respiratory and physiotherapy input

• Chest physiotherapy and airway clearance techniques
• Breathing exercises and graded activity programmes
• Support with ventilator weaning where appropriate
• Positioning and mobility to reduce the risk of chest infections
• Strength, balance and mobility training to regain independence in transfers and walking, where possible

Speech and language therapy

• Assessment and management of swallowing (dysphagia)
• Recommendations on food and fluid textures, and safe swallowing strategies
• Use of one-way speaking valves to restore voice where appropriate
• Support with communication, including low-tech and high-tech aids if the person cannot speak

Nursing care

• Day-to-day tracheostomy care, suctioning and tube changes in line with protocols
• Monitoring for complications such as infection, bleeding or blockage
• Support with personal care, nutrition, hydration and pressure area care
• Education for patients and carers on tracheostomy management, where appropriate

Occupational therapy

• Support with everyday activities such as washing, dressing and toileting
• Assessment for equipment and home adaptations
• Fatigue management and pacing strategies
• Planning for safe discharge and longer-term care needs

Nutrition and psychological support

• Dietetic advice to ensure adequate nutrition, especially after prolonged illness or tube feeding
• Psychological support for adjustment, anxiety and mood changes
• Support for family members and carers, including education about the condition and tracheostomy care

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Complications we aim to prevent or manage

Without experienced tracheostomy care and rehabilitation, people can be at higher risk of:

• Tube blockage or displacement
• Chest infections and respiratory failure
• Bleeding or infection around the stoma
• Pressure damage from tubes and ties
• Malnutrition, dehydration or weight loss
• Deconditioning, muscle weakness and reduced mobility
• Anxiety, low mood and reduced confidence

Our goal is to minimise these risks, promote safe weaning where appropriate, and support the best possible quality of life.

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Who may benefit from admission?

Inpatient rehabilitation at The Royal Buckinghamshire Hospital may be suitable for adults who:

• Have a tracheostomy and are medically stable but still require ongoing care
• Are in the process of ventilator or tracheostomy weaning
• Have neurological or complex medical conditions alongside tracheostomy needs
• Need coordinated rehabilitation to regain mobility and independence
• Require multidisciplinary planning for long-term care, equipment and discharge

We accept referrals from acute hospitals, intensive care units, surgeons, GPs, neurologists, rehabilitation consultants, case managers, solicitors and insurers.

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Referrals and further information

To discuss a potential referral for tracheostomy rehabilitation or to learn more about our services:

• Visit our Neurological Rehabilitation and Complex Rehabilitation pages
• Contact our referrals team by telephone or secure email

Our team aims to support each person living with a tracheostomy – and those who care for them – to achieve the safest possible breathing, communication and independence.